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Acute L-thyroxine overdose; therapy with sodium ipodate: evaluation of clinical and physiologic parameters
P D Berkner1, H Starkman, N Person
1Pediatric Endocrinology Center, Morristown Memorial Hospital, New Jersey 07960-1956.
Insights
Sodium ipodate effectively treated acute L-thyroxine overdose in children. This treatment lowered toxic triiodothyroxine levels without adverse effects, offering a potential new therapy for thyroid hormone emergencies.
Area of Science:
- Pediatric Endocrinology
- Clinical Pharmacology
- Toxicology
Background:
- Acute L-thyroxine overdose in children presents a significant clinical challenge.
- Elevated thyroid hormone levels (T4 and T3) can lead to serious health complications.
Observation:
- Two pediatric patients with acute L-thyroxine overdose were treated with sodium ipodate.
- Initial thyroxine (T4) and triiodothyroxine (T3) levels were critically high.
Findings:
- Sodium ipodate administration led to a decrease in T3 levels and a concurrent rise in reverse T3 (rT3).
- The therapeutic effect of sodium ipodate persisted for 72 hours with no observed toxicity.
- Thyroid hormone levels showed a correlation with systolic blood pressure.
Implications:
- Sodium ipodate demonstrates potential as a safe and effective treatment for acute pediatric thyroid hormone overdose.
- This finding may offer a novel therapeutic strategy for managing thyroid emergencies in children.
- Further research is warranted to explore the mechanism and broader application of sodium ipodate in thyroid dysfunction.
Abstract:
Two children with acute L-thyroxine overdose were treated with sodium ipodate, an oral cholecystographic agent. Initial thyroxine (T4) levels were elevated to 98.5 mcg/dL and 134.1 mcg/dL, with associated triiodothyroxine (T3) levels of 354 ng/dL and 402 ng/dL. T3 levels increased to a maximum of 662 ng/dL and 468 ng/dL. With administration of sodium ipodate, the T3 decreased with a simultaneous increase of rT3 level. Sodium ipodate effect lasted 72 hours. No toxic effect was noted. Interestingly, thyroid hormone levels correlated with systolic blood pressure but with no other physiologic parameter. Sodium ipodate appears to be a viable treatment modality for acute thyroid overdose in children.